Healthcare Provider Details

I. General information

NPI: 1013492453
Provider Name (Legal Business Name): MCKENZIE LAYNE MANRESA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MCKENZIE L MONTGOMERY

II. Dates (important events)

Enumeration Date: 10/02/2018
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 SW 20TH PL
OCALA FL
34471-7734
US

IV. Provider business mailing address

2111 SW 20TH PL
OCALA FL
34471-7734
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-4251
  • Fax: 352-622-0102
Mailing address:
  • Phone: 352-622-4251
  • Fax: 352-622-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9111695
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: